7. 8. 9.

V. N. Favorina, Zh. Nevropat. Psikhiat., No. i, 81 (1965). M. V. Yastrebova and V. S. Yastrebov, Zh. Nevropat. Psikhiat., No~ i, 66 (1973). V. M. Morozov and Yu. K. Tarasov, Zh. Nevropat. Psikhiat., No. 4, 44 (1951).

DELUSIONS OF SELF-JUSTIFICATION, INNOCENCE, PARDON, AND ACQUITTAL IN SCHIZOPHRENIA L. I. Abramova

UDC 616.895.8-07:616.89-008.444.1

The first account of delusions of innocence and pardon was given in 1857 by Delbruck [i], who classed this type of pathology as a prison psychosis. In delusions of innocence, the patient had a delusion that he was innocent of the crime for which he had been accused, and in delusion of pardon that the sentence on his case had been set aside and he had been pardoned. Sommer [2] described delusions of innocence and pardon among the class of "insanity of the imprisoned." Other workers [3] observed similar delusions in "acute hallucinatory melancholia," "acute and subacute paranoia," "acute hallucinatory mania," and "chronic paranoia." Later various writers [4-10] noted the nosological nonspecificity of delusions of innocence and pardon. Delusions of innocence, pardon, and acquittal in schizophrenia arising during the period of trial and forensic psychiatric examination have been excellently discussed by Ii'inskii and Savchenko [13, 14]. The stages of its development from a paranoid personality to the formation of overrated and later of delusional ideas of innocence, pardon, and acquittal, with the subsequent addition of a delusion of persecution, have been distinguished. The special features of the delusions depending on the course of the disease have been demonstrated. It is stated in the literature that delusions of innocence are also observed apart from situations of psychogenic trauma. According to Kraepelin [15], in melancholia cases often arise when, patients, in a gloomy mood, "fight against their self-reproaches with all their strength." Bieuler [16] noted that to a patient with melancholia, who expected punishment for delusionary motives, it seemed undeserved. Korsakov [17] wrote that in melancholia the delusion of expecting punishment and imprisonment was combined with a distinctive delusion of persecution. The patient considers that in fact he is not guilty, guilt has been laid upon him through a misunderstanding, through his own neglect or through the cruelty of other~ This paper is devoted to a description and analysis of delusions of self-justification, innocence, pardon, and acquittal in schizophrenia in situations unconnected with psychogenic trauma. The author investigated 46 patients (27 women and 19 men) aged from 21 to 74 years with schizophrenia. The duration of the disease varied from a few days to many years. The duration of observation varied from a few months to 3 years. Depending on the course of their illness the patients were divided into two groups. Group 1 included 9 patients with paranoid schizophrenia, group 2 contained 37 patients with ' a diagnosis of episodic, progressive schizophrenia. The investigation showed that the ideas whereby the patients denied their guilt at the conclusion of a true or imaginary trial may be manifested not only as delusions, but also as overrated ideas. Overrated ideas of self-justification are directed toward minimizing guilt in a true trial, the patients' thoughts and actions are subordinated to this aim, although for a certain time the patients can be persuaded to the contrary. Overrated ideas of self-justification are combined with overrated ideas of self-accusation and condemnation, they are accompanied by anxious-depressive emotions, and are observed during superficial atypical depression. The patients declared that people around them were evidently judging Department of Psychiatry, Central Postgraduate Medical Institute, Moscow. Translated from Zhurnal Nevropathologii i Psikhiatrii imeni S. S. Korsakova, Vol. 76, No. 5, pp. 730736, May, 1976. Original article submitted August 21, 1975.

0097-0549/78/0901-0049507.50

9 1979 Plenum Publishing Corporation

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them for their had behavior, for some misdemeanor, for some rather tactless attitude toward relatives, and so on (these actually happened), they attempted to justify themselves activel~ they stated they had been improperly brought up in the family, had not received the proper attention, that their mood was depressed, that what had happened to them was purely accidental, that they trusted the doctor in every way, and that they would not repeat "a similar fault" in the future. Patient K., for instance, a woman aged 69 years, having accidentally tried to open the door into a stranger's room, because she mistook it for her own, decided that this could be an excuse for accusing her of robbery. She was overwhelmed by thoughts such as these, so that when she sat in the yard with her neighbors the conversation turned on this theme alone, she related the circumstances of what had happened, laying special emphasis on the fact that everything had happened accidentally, she ascertained the attitude of her audience to the situation, which made it easier for her for a time when she heard that the same thing had happened to other people as well. Later she developed an acute delirious attack with a delusion of self-justification. Delusional self-justification (in the wide sense of the term) is aimed at the denial of imaginary guilt. The patients consider that their statements and actions are sensible and well grounded, they are convinced of their own innocence of the imaginary crime or misdemeanor, their statements cannot be corrected, they are closely connected with other types of delusion and with hallucinations that form part of the structure of various syndromes, and they are manifested as delusion of self-justification, innocence, pardon, and acquittal. Investigation showed that delusional ideas of innocence differ in their mode of expression and they are reflected differently in the patients' behavior. In the writer's view the concept of delusion of self-justification can therefore be used together with the concept of delusion of innocence. The delusion of self-justification is characterized by the fact that the patients categorically deny their imaginary guilt and justify themselves. This delusion does not exist in isolation but always in connection with delusions of persecution, judg -~ ment, attitude, and guilt. Patients with delusions of innocence, by contrast with delusions of self-justification, partly accept their imaginary guilt and justify themselves passively. This delusion is combined with a depressive delusion of self-accusation, delusions of persecution, judgment, and attitude, verbal hallucinations, and pseudoha!lucinations of an accusatory character. In delusions of pardon and acquittal the patients consider that their pardon and acquittal arise from intervention by higher authorities, statesmen, or God. Delusions of pardon and acquittal coexist with delusions of persecution and with hallucinations and pseudohallucinations. Delusions of self-justification and innocence are detected in the structure of depressive, paranoid-depressive, hallucinatory-paranoid, acute delusional, and paraphrenic syndromes; delusions of pardon and acquittal occur episodically in hallucinatory-paranoid and paraphrenic syndromes. Delusions of self-justification in the structure of delusional depression are closely connected with delusional ideas of attitude, judgment, and persecution and are characterized by the activity of the delusional expression and behavior, aimed at denying the imaginary guilt. The system of the patients' evidence is distinguished by its external plausibility and logic. The patients state that they do not feel guilty, they describe themselves as honest people, conscientious and hard working, "incapable of any meanness," they recount their good points, and consider that in this way their innocence will be confirmed. As an example the following case may be cited. Patient Z., a woman aged 49 years, whose job was to make meals for children. When she developed the delusion of conviction, she considered that she was being accused of lack of cleanliness; in her conversations with her fellow workers she insisted that this had never been a fault of hers. On arriving for work she emphasized the cleanliness of her clothes and her neatly combed hair, and she always tried to put on new garments. She invited her fellow workers to her home and showed them piles of clean underclothes and how everything in the room was clean. She carefully washed her hands before every work operation. To everybody within sight she would say: "they cannot accuse me of anything."

50

Patient P., a woman aged 42 years, a factory worker, considered that the attitude of the factory administration to her had changed because someone had accused her of something; she went up repeatedly to the foreman and begged him to believe that she was well disposed to him, and she categorically denied that she was capable of making unflattering remarks about him. As proof she produced certificates and awards given her for good work, she explained that she was a deserving person, that she could be trusted, and that she would not allow herself to commit such reprehensible crimes. During that period the patient worked harder than usually, she was ready to help her fellow workers, and by all her behavior she tried to show that she was incapable of meanness. Delusions of innocence during depression, if not connected with other psychopathological ideas such as delusions of self-justification, may be combined with depressive delusions of self-accusation. Delusions of innocence and self-justification are also observed in the paranold-depressive syndrome. Under these circumstances the delusions of self-justification are combined with delusions of persecution, and accusation, and with the Kandinsky--Clerambault syndrome, and it is manifested as the "double" phenomenon. The patients insist that the accusation is unjustified, that the crime of which they are suspected was committed not by them, but by their "doubles," that somebody is "masquerading" as them, that they have been slandered, and that they are acting on them with malice aforethought. The patients' behavior, like their statements, is relatively active and logical. Patient A., a man aged 25 years, considered that his "thoughts of spying" had been found out and, that on this basis, the physicians and the organs of State security would come to the conclusion he had been engaged in "spying activity." He recorded his thoughts in two copies, gave one to his father in case he were brought before the court, which he expected on the grounds of delusional motives, he told the physicians and othe r people he met that the thoughts were not his own, and that they had forcibly imprinted them in his head with malice aforethought. Delusions of self-justification in the hallucinatory-paranoid syndrome are connected not only with delusions of persecution and conviction and with the Kandinsky-- Clerambault syndrome, and the delusion of a "double" but also with auditory hallucinations (the "hallucinatory information" phenomenon [18]), which provide the patients with material to confirm their delusional ideas. The justifying arguments of these patients are similar to those in the paranoid-depressive syndrome. They energetically state their displeasure over the accusation, they state that they have irrefutable evidence of their innocence, and so on. In some cases the evidence of innocence is episodically "whispered by voices" to the patients. Their behavior is active. Outwardly it resembles the behavior of a "persecuted persecutor." The patients appeal to the courts and to various state institutions with the request that they support them, punish the true criminals, and acquit themselves. Patient S., a woman aged 54 years, a report reader, works with classified documents. She suffers from auditory hallucinations. Voices accuse her of obtaining living space illegally and of treachery to her country. She went repeatedly to the Housing Committee, where she declared that she had obtained her living space legally and requested confirmation of it. She defended her rights passionately in conversation with the physician and declared that she was not "greedy," but that she was "an honest person, really honest," she had been a production worker for 30 years, that "important secret documents" had passed through her hands but she had never given them to anyone else, and stated that she was being accused because they wished to obtain her living space. Patient F., a man aged 45 years, said that a voice had accused him of drunkenness,of illegally obtaining disability benefits, and of obtaining money under false pretences; he said that society called him a "thief and fascist." He actively defended himself, denied the accusations made, gave detailed proof of how he had deserved to be given a pension, how whenever his condition worsened he would go to the dispensary with the request for a "full examination" for the annulment of his disability pension. He considered that this helped him to become finally acquitted and to stop the persecution, declaring that he was an "innocent man" and that "they had used him on purpose as an example." In the acute delusional syndrome delusions of self-justification are connected with delusions of persecution and conviction, and with auditory hallucinations and pseudohallucinations; they are manifested in the structure of the Kandinsky-- Clerambault syndrome together

51

with the "double" phenomenon. The patients' statements describing them are similar to those in the previous syndromes but differ in their fragmentary and illogical character. Delusions of innocence are observed in the structure of all the above-mentioned syndromes and they are connected with the same psychopathological formations as delusions of selfjustification, as well as with delusions of self-accusation. In syndromes with a paraphrenic structure, besides delusions of self-justification and innocence, delusions of pardon and acquittal also were observed. Delusions of innocence could be found in the picture of confabulatory paraphrenia with marked anxious-depression affect. It was connected with delusions of persecution and accusation and with confabulatory formations. Patient L., a man aged 54 years with confabulations and mental automatisms, who considered that he was being accused of a large number of "faults," agreed with this but at the same time declared that he had led his life otherwise, and he would not have been such a "wicked" man if his teachers had not chosen him for their own experiments and had given him an injection since childhood in order to "program" him, so that in his later life they could use him to study the effect of harmful factors on man. Patient P., a man aged 28 years, expected punishment because of his imaginary "high" origin and because he had committed imaginary crimes; he agreed that he was guilty of all this, but by way of justification he produced confabulatory inventions about his services during the war, on the grounds that this would reduce his guilt. In hallucinatory paraphrenia delusions of self-justification, innocence, and acquittal were observed. Delusional ideas were expressed actively by the patients, who drew on them for the substance of their delusions of persecution and, in particular, hallucinations and pseudohallucinations of an antagonistic situation~ The patients declared that they were innocent, that they had protection in the face of God and statesmen who had themselves "told them so," that they were being pardoned or acquitted, and they sometimes spoke about this as an accomplished fact. The patients' mood was elated or euphoric, they had no clear disturbances of behavior, they could undertake purposive work, and they spoke only when they were spoken to. The types of delusions studied occupy a subordinate position in the episode relative to other psychopathological disorders, without which they cannot exist. However, the more clearly and systematically the delusions of persecution and the hallucinations and pseudohallucinations of an accusatory character, the more systematic the delusions of self-justification and innocence, although under these circumstances also they are subordinate in position. The appearance of delusions of pardon and acquittal is evidence of a less pressing nature of the delusions of persecution. The facts described above indicate that delusions of self-justification and innocence are manifested in their purest form in syndromes with a less complex structure (depression with delusions of attitude, or of conviction), and the delusory statements of the patients and their behavior are active, logical, purposive. In syndromes with a more complex structure (paranoid-depressive, hallucinatory-paranoid, acute delusory) the delusions of selfjustification and innocence occupy an increasingly subordinate position relative to the other psychopathological features (delusions of persecution, hallucinations and pseudohallucinations with confabulations of guilt, the Kandinsky-- Clerambault syndrome), drawing on them for their content; the patients' delusory statements and behavior remain active. In syndromes with a paraphrenic structure on the appearance of delusions of pardon and acquittal the activity of behavior and of the patient's expressions clearly decreases. Since the types of delusions studied are always connected with delusions of persecution, we can speak of the antagonistic structure of this syndrome and of antagonistic delusory ideas (a combination of delusions of persecution and the delusions of protection described by Seglas ~19], when the patients draw protection and support from their own delusions). Absence of dissimulation is characteristic of patients with all the types of delusions described above. Turning to an account of delusions of self-justification, innocence, pardon, and acquittal as they depend on the type of course of the disease, the following remarks can be made. In paranoid schizophrenia we observed delusions of innocence and self-justification at the hallucinatory-paranoid and paraphrenie stages and delusions of pardon and acquittal at 52

the stage of hallucinatory paraphrenia. The systematization of the delusions depended on the degree of progressiveness of the disease and the severity of the disturbance of thinking. With a more malignant type of course of the disease the delusory ideas became fragmentary and stereotyped. With a less progressive type of course of the disease they were more logical and connected. Episodic-progressive schizophrenia is characterized by the occurrence of delusory ideas of innocence and self-justificatio~a~ different stages of the disease: at the beginning of the episode, at its height, and on recovery from their psychotic state. They can exist together or alternate depending on the dynamics of the episode. Their severity is determined by the psychopathological structure of the attack and the acuteness of the mental state. Delusions of pardon and acquittal arise at the paraphrenic stage. Episodes in whose structure the delusions described above occur have a tendency to run a protracted course. In individual patients long before the appearance of delusions of self-justification, warnings of future self-justification could be observed. At the stage of impending delusions, before it was known what caused the various alerting phenomena, but with a premonition of impending evil~ the patients attempted to obtain support from various institutions. For example, one patient went to the police and warned them about the improper behavior of his neighbor, another got a job as a supernumerary assistant on a newspaper, and so on. Delusions of self-justification, as the follow-up study showed, often turned into remissions. Three main types of remission were observed. In remissions of one type the patients had a constant fear of being accused of something, with a tendency toward irrational doubts. All their behavior was permeated with the desire to protect themselves against mistakes should possible complications arise. Meanwhile their premorbid features were accentuated, the patients became even more expeditious, they attempted to understand everything scrupulously, and they repeatedly verified that the work that they had done was correct. This type of remission is both hypersthenic and delusory at the same time, which distinguishes it from the usual type of hypersthenic remission [20, 21]. The second type of remission is characterized by the presence of residual delusions of innocence and self-justification. It can be classed as a paranoid type of remission [20, 21]. In the third type the remissions are incomplete, with residual delusory disturbances and cyclothymic-like fluctuations of mood. On stabilization of the remission, the delusions of self-justification are residual; on the appearance of cyclothymic-like subdepressions, instead of delusions of self-justification delusions of innocence appear; these occupy a subordinate position relative to the revived ideas of self-accusation, persecution, and condemnation; some patients, however, turn at this stage to various authorities with the request to stop the persecution in view of the trivial nature of their misdemeanor and to justify themselves. In cases of cyclothymic-like submania delusions of self-justification begin again. The patients whom we observed in remission did not express their delusory ideas actively. Meanwhile, at work and in their everyday life, they showed a pathological urge to show their best side. This type of remission is closer to that described as thymopathic [22]. In the cases studied there was no situation of psychogenic trauma, and it is therefore impossible to speak of the psychogenic (pathoplastic) genesis of the psychopathological disorders present. This suggests that t~ere are other foundations on which these delusions may arise. One such source, in the writer's opinion, could be premorbid characteristics of the personality. Several workers [23-25] recognize a connection between the type of personality and the characteristics of the disease which the patients subsequently develop. In the premorbid state our patients also were characterized by a constant feeling of certainty about their own innocence and superiority, an increased desire for justice, a feeling of responsibility, increased ability to work and to work expeditiously, scrupulousness, purposiveness, hut by lack of frankness in their outward sociableness. With some reservations these patients could be assessed in the premorbid state as sthenic schizoids. A very few patients showed asthenic features: awkwardness in the presence of other people, increased sensitivity to insults. These personality features may perhaps affect the formation of the delusions of self-justification and innocence.

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LITERATURE CITED i. 2. 3. 4. 5. 6. 7. 8. 9. i0. I!. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.

A. Delbruck, Allg. Z. Psychiat., 14, 349 (1957). W. Sormner, Allg. Z. Psychiat., 40, 88 (1884). Kirn, Allg. Z. Psychiat., 45, 1 (1889). R. Krafft-Ebing, Lehrbuch der Psychiatrie, Vol. I, Stuttgart (1883), po 180. E. Rudin, Allg. Z. Psychiat., 58, 447 (1901) o E. Kraepelin, Psychiatrie, Vol. 2, Leipzig (1915), p. 1502. E. Kraepelin, Introduction to Clinical Psychiatry [Russian translation], Moscow (1923). V. V. Lyustritskii, Psikhiat., Nevrol., Eksp. Psikhol., No. 3, 87 (1923). K. Birnbaum, Kriminalpsychopathologie und psychologische Verbrecherkunde, Berlin (1931). V. P. Osipov, Textbook of Psychiatry [in Russian], Moscow--Leningrad (1931), p. 455. I. N. Vvedenskii, in: Problems in Forensic Psychiatry [in Russian], No. 1 (1938), pp. 5-44. N. I. Felinskaya, Reactive States in Clinical Forensic Psychiatry [in Russian], Moscow (1968), p. 67. Yu. A. II'inskii and V. I. Savchenko, Zh. Nevropat. Psikhiat., No. 9, 1355 (1974). V. I. Savchenko, in: Current Problems in Psychiatry [in Russian], Minsk (1973), p. 53. E. Kraepelin, Psychiatry [in Russian], Part 2, St. Petersburg (1898), p. 247. E. Bleuler, Textbook of Psychiatry [Russian translation], Berlin (1920). S. S. Korsakov, A Course in Psychiatry [in Russian], Moscow (1901), p. 73. E. S. Petrova, Zh. Nevropat. Psikhiat., No. 9, 1384 (1967). D. J. Seglas et al., Ann. Med. Psycho!., Year 47, 9, 5 (1889). V. M. Morozov and Yu. K. Tarasov, Zh. Nevropat. Ps~khiat., No. 4, 44 (1951). G. V. Zenevich, Remissions in Schizophrenia [in Russian], Leningrad (1964). N. M. Zharikov, M. S. Popova, and L. A. Stankevich, Vest. Akad. Med~ Nauk SSSR, No. 3, 82 (1966). E. Bleuler, Z. ges. Neurol. Psychiat., 78, 379 (1922). F. Mauz, Z. ges. Neurol. Psychiat., 86, 119 (1923). J. Berze, Z. ges. Neurol. Psychiat., 9-6, 646 (1925) o

UNIT ACTIVITY IN THE HYPOTHALAMIC ARCUATE AREA IN RATS AT DIFFERENT STAGES OF THE ESTROUS CYCLE V. N. Babichev and V. Ya. Ignatkov

UDC 612.826 + 612.621

Changes in sensitivity to dopamine in various stages of the estrous cycle were studied in rats by microiontophoretic application to single neurons of the hypothalamic region and recording unit activity. Most arcuate neurons during the first half of the day in proestrus were shown to respond to dopamine by activation, to correspond to the raised plasma estrogen level in this phase of the estrous cycle. During the second half of the day in proestrus, when the estrogen level is minimal, and in stage diestrus-2, of all the neurons recorded the great majority responded to dopamine by inhibition.

The role of the CNS in the regulation of pituitary gonadotropic function is no longer in dispute. Both cortical and subcortical structures of the CNS, such as the limbic system, hippocampus, and so on, are known to play a role in this regulation [10-12]. In the final analysis, however, hypothalamic structures are the principal point where information is relayed in the system of neuroendocrine relations from the nervous component to the humoral stages~ The multicomponent system of the hypothalamus has a virtually unlimited number of information inputs. Incoming information, varied in modality, converges on its structures and it forms subsequent regulatory influences on a qualitatively and quantitatively strictly defined number of hypothalamic outputs. The hypothalamus is a vital component of the funcLaboratory of Physiology of the Endocrine System, Institute of Experimental Endocrinology and Hormone Chemistry, Academy of Medical Sciences of the USSR, Moscow. Translated from Fiziologicheskii Zhurnal SSSR imeni I. M. Seehenova, Vol. 62, No. 4, pp. 516-522, April, 1976. Original article submitted July i0, 1975. 54

0097-0549/78/0901-0054507.50

9 1979 Plenum Publishing Corporation

Delusions of self-justification, innocence, pardon, and acquittal in schizophrenia.

7. 8. 9. V. N. Favorina, Zh. Nevropat. Psikhiat., No. i, 81 (1965). M. V. Yastrebova and V. S. Yastrebov, Zh. Nevropat. Psikhiat., No~ i, 66 (1973)...
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